A new study warning Australia’s major cities are likely to reach highs of 50C by 2040 – even if the world meets its target of limiting warming to 2C above pre-industrial levels – is yet more evidence that without immediate and urgent action we are facing a looming public health crisis during heatwaves and other extreme weather events.
The study follows recent unseasonable heat across New South Wales, with Sydney experiencing its hottest ever September day, as well as the doubling of record-breaking summer temperatures in Australia in the past 50 years. This new normal has hospital health professionals particularly bracing for the coming summer.
Public Australian emergency departments are tough places to both work and be a patient. They are hectic, often overwhelmed, not infrequently threatening environments that are emotionally demanding for everyone. And, with ever increasing demand and an ageing population, along with a politically-sensitive health budget, the emergency department is increasingly the public face of a stressed health system.
Every day, sometime around 11am, the ambulances roll in. This is when we see the presentation rate suddenly increase, commonly bringing a new patient every three to four minutes, a rate that will continue until 10-11pm every evening. Generally during this 11 to 12 hour period we see two-thirds of our presentations. This is the time that the department heaves.
During this period, on any given day, the resuscitation area will be full. A delirious elderly patient with septicaemia will be lying alongside someone with chest pain who may be next to a psychotic methamphetamine-intoxicated patient screaming abuse as they are restrained by security and clinical staff, while a full resuscitation of an out of hospital cardiac arrest or a major trauma takes place in a nearby bay.
Monitor alarms will be going off continuously, the sounds broken by an ambulance priority-one call coming through, while medical and nursing staff will be moving from one patient to the next as quickly as possible, trying to keep on top of the deteriorating patients around them. And soon enough ambulances will be banking up outside the front door as the department exceeds its capacity to deal with the influx, kept from being on the road responding to emergencies as they wait to offload their patients.
While all this is going on, the inpatient units are being pushed to discharge as many patients, as early as possible in the day, to make capacity for the admissions that will come, both as emergency and elective surgical patients. All of this has to happen, has to work to an optimal level to deal with the demand of any usual day in our public health system.
Now let us add to this day three of a heatwave (defined as three or more days of high maximum temperatures). With climate change causing a gradual increase in average temperatures, we know that heatwaves are more frequent and of increasing severity.
What we also know from the heatwaves we have seen in Australia thus far is that we can expect a very significant impact on our public health system. Increases of up to 25% for ambulance emergency call outs; up to 60% increase in emergency department resuscitation cases, often in the elderly and vulnerable members of our society; an overall increase in presentations to our already overstretched emergency departments; and an increase in overall deaths ranging from 13% to 24%. In the 2014 Melbourne heatwave, that equated to 167 excess deaths.
One hundred and sixty seven deaths. If that had been a fire, or explosion, or heaven forbid a terrorist attack, it would be a national disaster that would be in the public eye for days. Yet it will happen reliably with every major heatwave event, and we barely bat an eyelid.
These issues are discussed in an article in the current edition of the Medical Journal of Australia, which I co-authored with former Australian of the Year, Professor Fiona Stanley, and public health physician, Dr Marion Carey.
And it is not just these direct consequences that are significant. There is always a huge demand on public hospital beds, many hospitals running at or beyond a level of occupancy that allows for efficient systems. What this means is that even without additional burdens such as heatwaves, it is a constant struggle to create capacity for those who need admission. Events such as heatwaves only exacerbate this pressure, resulting in reduced access for all patients, not just those affected by heat-related illness.
So, with the prospect of increasing extreme weather along with the so many other challenges of climate change we have some serious questions to address.
Are we going to take the health of our population and our ecosystem seriously and do everything we can to mitigate the inevitable increase in ambient temperature? How do we minimise the completely unacceptable mortality rates that we are already seeing, and what do we do to invest in our health systems to cope with what will be an ever increasing burden?
First published in The Guardian on 4 October 2017.
Dr Mark Monaghan is an emergency physician and a member of Doctors for the Environment Australia